Abstract
BackgroundNeonatal hypernatremic dehydration is prevented by daily neonatal weight monitoring. We aim to provide evidence-based support of this universally promoted weighing policy and to establish the most crucial days of weighing.MethodsWeight measurements of 2,359 healthy newborns and of 271 newborns with clinical hypernatremic dehydration were used within the first seven days of life to simulate various weighting policies to prevent hypernatremic dehydration; its sensitivity, specificity and positive predictive value (PPV) of these policies were calculated. Various referral criteria were also evaluated.ResultsA policy of daily weighing with a cut-off value of -2.5 Standard Deviation Score (SDS) on the growth chart for weight loss, had a 97.6% sensitivity, 97.6% specificity and a PPV of 2.80%. Weighing at birth and only at days two, four and seven with the same -2.5 SDS cut-off, resulted in 97.3% sensitivity, 98.5% specificity and a PPV of 4.43%.ConclusionA weighing policy with measurements restricted to birth and day two, four and seven applying the -2.5 SDS cut-off seems an optimal policy to detect hypernatremic dehydration. Therefore we recommend to preferably weigh newborns at least on day two (i.e. ~48h), four and seven, and refer them to clinical pediatric care if their weight loss increases below -2.5 SDS. We also suggest lactation support for the mother, full clinical assessment of the infant and weighing again the following day in all newborns reaching a weight loss below -2.0 SDS.
Highlights
Breastfeeding is the most complete and balanced nutrition, it contains antibodies, enzymes, hormones and all the necessary nutrients in ideal proportions [1, 2]
A policy of daily weighing with a cut-off value of -2.5 Standard Deviation Score (SDS) on the growth chart for weight loss, had a 97.6% sensitivity, 97.6% specificity and a positive predictive value (PPV) of 2.80%
A weighing policy with measurements restricted to birth and day two, four and seven applying the -2.5 SDS cut-off seems an optimal policy to detect hypernatremic dehydration
Summary
Breastfeeding is the most complete and balanced nutrition, it contains antibodies, enzymes, hormones and all the necessary nutrients in ideal proportions [1, 2]. In some cases successful initiation breastfeeding seems to fail due to inadequate latching, milk production or intake [4]. This may cause hypernatremic dehydration in the newborn [5]. Some studies imply that daily weighing, especially during the first five days, is the most effective intervention [10, 11]. A reliable weighing policy detects at an early stage all cases with hypernatremic dehydration (high sensitivity) at the account of a very limited number of unnecessary referrals (high specificity). We aim to provide evidence-based support of this universally promoted weighing policy and to establish the most crucial days of weighing
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